Implementation of melanoma guidelines in the multidisciplinary setting: A qualitative analysis.

Autor: Mott NM; University of Michigan Medical School, Ann Arbor, MI, USA; University of Michigan, Center for Healthcare Outcomes and Policy, Ann Arbor, MI, USA; University of Colorado Anschutz Medical Campus, Department of Surgery, Aurora, CO, USA. Electronic address: nmmott@umich.edu., Duncan ZN; The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA., Pesavento CM; University of Michigan Medical School, Ann Arbor, MI, USA., Vastardis AF; University of Michigan Medical School, Ann Arbor, MI, USA., Bredbeck BC; University of Michigan, Center for Healthcare Outcomes and Policy, Ann Arbor, MI, USA; University of Michigan, Department of Surgery, Ann Arbor, MI, USA., Harter CA; University of Michigan Medical School, Ann Arbor, MI, USA., Dossett LA; University of Michigan, Center for Healthcare Outcomes and Policy, Ann Arbor, MI, USA; University of Michigan, Department of Surgery, Ann Arbor, MI, USA., Broman KK; The University of Alabama at Birmingham, Birmingham, AL, USA., Hughes TM; University of Michigan, Center for Healthcare Outcomes and Policy, Ann Arbor, MI, USA; University of Michigan, Department of Surgery, Ann Arbor, MI, USA. Electronic address: tmhughes@med.umich.edu.
Jazyk: angličtina
Zdroj: American journal of surgery [Am J Surg] 2023 Feb; Vol. 225 (2), pp. 335-340. Date of Electronic Publication: 2022 Sep 25.
DOI: 10.1016/j.amjsurg.2022.09.039
Abstrakt: Background: Data suggest variation in utilization of completion lymph node dissection (CLND) and adjuvant systemic therapy (AT) for sentinel lymph node-positive melanoma. We aimed to explore how clinicians consider multidisciplinary treatment options.
Methods: We conducted semi-structured interviews of surgical oncologists, medical oncologists, and otolaryngologists to produce a thematic analysis.
Results: Participants (n = 26) described melanoma care as inherently "multidisciplinary," noting the importance of conversations facilitated by shared clinic days or space. Despite believing that their practice mirrored other clinicians, participants revealed diverging perspectives on CLND and AT. Multidisciplinary care presented challenges for surveillance as surgeons expressed desire to retain ownership of patients but did not feel comfortable overseeing AT needs. Participants questioned the fidelity of nodal ultrasounds, noted redundancy in their roles, and described a "surveillance burden" for patients.
Conclusion: Opportunities exist to improve multidisciplinary melanoma care through broader consensus of how to translate emerging data into patient care and delineating surveillance roles.
(Copyright © 2022 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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